Significant Publications

Adolescents were interviewed about health care preferences, including privacy and confidentiality. Adolescents expect and value all aspects of health care privacy. Although confidentiality is most important, privacy was also important, and included reluctance to discuss issues with multiple providers. Other privacy issues extended to gender preference of providers, similar to other studies. Providers should address both informational privacy (confidentiality) as well as psychological, social, and physical privacy of adolescent patients.

In a cross-sectional analysis, trait anxiety and depressive symptoms were associated with body mass index (BMI) and percent body fat (as measured by DXA scan). Body fat, a measure of adiposity, was associated with symptoms of psychological distress, as measured by anxiety and depression.

This study documented that HIV testing rates in adolescents increased significantly after national recommendations for routine testing, and further increased following introduction of rapid testing. Combining routine testing with rapid testing modalities may increase uptake of HIV testing among adolescents in primary care settings.

This study documented that adherence to recommended intervals and completion were low in an urban medical center. Lower rates of completion were observed by race and insurance status, raising concern that disparities in vaccine completion could exacerbate existing disparities in cervical cancer. The results led to changes in vaccine administration policies, to address rates of completion.

Division Highlights

Tanya Kowalczyk Mullins, MD

This year one of our junior faculty members was awarded the prestigious “Procter Scholar” from the Cincinnati Children's Hospital Research Foundation. Dr. Tanya Mullins received the two- year award which is designed to prepare physicians for biomedical or clinical investigative careers in pediatrics. The program provides both financial support and appropriate scientific mentoring in preparation for becoming an independent investigator. Often the award has gone to a bench scientist and Dr. Mullins is among the first of clinical researchers to receive the award.

A key focus of Dr. Mullins’ work is to gain knowledge critical to the development of effective interventions targeting adolescents, parents, and healthcare providers to prevent adolescent risky sexual behavior and acquisition of sexually transmitted infections (STIs). Since adolescents are at high risk for acquiring STIs, examining factors that may contribute are crucial. Adolescent health-related behaviors are influenced by communication with parents and healthcare providers. However, they also may be related to disease specific factors such as HIV viral load, as these may influence sexual behaviors. Even though parental and provider communication influences adolescent health-related behaviors, no studies to date have examined parental and provider communication concurrently as they relate to adolescent risky sexual behavior. Further, the role of HIV-infection related factors in risky sexual behavior in HIV-infected adolescents has not been explored. During the time of the Procter award Dr. Mullins proposes to gain understanding of adolescent sexual behavior and incident sexually transmitted infections (STIs) using two different longitudinal datasets. Her aims are to: 1: Explore the role of maternal and provider communication in adolescent sexual behavior and incident STIs and 2: Explore adolescent sexual behavior and rates of incident STIs in a cohort of HIV-infected and uninfected but at-risk male and female adolescents. The second aim was presented at the annual meeting of the Pediatric Academic Societies in the spring of 2011. The design of interventions to decrease adolescent risk behavior requires an understanding of the complex factors affecting adolescent sexual behaviors. These analyses will be used to support future proposed research applications to be submitted to the National Institutes of Health and other relevant funding sources.

Jessica Kahn, MD, MPH

A second highlight within our division is Dr. Jessica Kahn’s continued collaboration with The Department of Reproductive Health Research of the World Health Organization (WHO). Dr. Kahn facilitates a global, on-line network related to cervical cancer prevention and the role of HPV vaccines. The network is jointly sponsored by the WHO, UNFPA, and CCHMC. The goals of the HPV Vaccine CoP are to enable health professionals globally to: 1) share knowledge, experience, and resources regarding cervical cancer prevention; 2) add their opinions to the global policy and practice dialogue on enhancing cervical cancer prevention programs and establishing HPV vaccination programs; and 3) access strategies for cervical cancer prevention program implementation. The network currently has more than 1100 members from 118 countries. Activities include posting announcements, educational resources, and advocacy tools; providing a monthly newsletter; conducting interactive discussions that allow members to share their experiences and resources; and organizing two global videoconferences about cervical cancer prevention: one focusing on the American, European, Mediterranean and African regions, and the other on the Asia-Pacific region.

Research InterestsWeight-related disorders and associated psychological disturbances; how hormones which regulate hunger/satiety and metabolism are impacted by psychological disorders to impact weight and nutrition

Significant Accomplishments

Continued Studies of the Environment on Puberty

A significant paper, featured in Pediatrics (Pediatrics 2010;126:e583-90), demonstrated that girls are maturing at younger ages than previously reported. The findings were an outgrowth of our “Continued Studies of the Environment on Puberty” project, a longitudinal NIH-funded multi-site study headed by Frank Biro, MD, principal investigator. Several division members, as well as members of Biostatistics and Epidemiology, and the UC Department of Environmental Health, also participate in this project, which includes epidemiology, community outreach and translational cores. This continues the work of a previous seven-year project, “Puberty and Cancer Initiation.” We seek to understand the influences of environmental exposures on timing of puberty, as well as whether these exposures could be related to the relationship of timing of menarche on risk of breast cancer. Participants are seen annually in the Clinical Translational Research Center (CTRC). A related NIH project, “Impact of Peripubertal Exposure to Xenohormones on Fat Distribution and Cytokines,” explores environmental exposures on the relationships between bone mineral content, insulin resistance, and cytokines during pubertal maturation.

Office of Faculty Development

The Office for Faculty Development (OFD), housed within the Division of Adolescent Medicine, was launched in May 2010. The office seeks to enhance the academic environment within the Research Foundation to support and reward professional activities among faculty; promote recruitment, retention and career advancement; improve promotion rates and leadership opportunities for women and minority faculty; enhance career and work-life satisfaction; and provide faculty with resources to advance their careers. The office, directed by Jessica Kahn, MD, MPH, Assistant Chair of Academic Affairs and Faculty Development, offers monthly career seminars, a grantsmanship training program and a core leadership training program.

Asthma Innovation Lab

The Asthma Innovation Laboratory bridges research and health care improvement. Clinical activities, led by Maria Britto, MD, MPH, are housed within the Teen Health Center. The Lab develops and prototypes care delivery innovations, translates existing research resources into practice-friendly tools, and uses quality improvement methods to continuously enhance the clinical care it provides to nearly 180 adolescents with asthma. In the past year, our interventions helped 60 percent of our patients with poorly controlled persistent asthma achieve good control, compared to 25 percent the prior year. Interventions included vigorous contact (phone, texting, schools), as well as tracking and coordinated delivery of available evidence-based care (trigger avoidance, skill development, treatment of co-morbidities). We also have encouraged 35 percent of our patients to enroll in one or more research projects. Our upcoming focus will be to serve as a pilot site for a comprehensive Epic-based population management system and improving coordination between primary and specialty asthma care.